December 14, 2017 (symptom set: first formal compilation)
Here is a set of symptoms that I experience.
Here is a set of symptoms that I experience.
Heart
General:
All of my cardiac symptoms have subsided somewhat. Exercise seems to
have a long-lasting impact on cardiac measures. Heart rate seems
elevated for hours after light to moderate exercise. For this reason, I
think that the measurements in medical settings have been exaggerated
simply by virtue of traveling to the appointment (I don't have a car, so
that usually involves walking). I recall a measurement a while ago with
a heart rate of 120 and blood pressure of 90/50.
Tachycardia:
My tachycardia has largely subsided. I think this is a result of things
I've been doing. It may be my bias talking, but I think that my heart
rate is usually higher when my blood pressure measures low. The 24 hour
EKG I did a while ago found an average of 95 bpm, (1).
It seems that 90 bpm, as opposed to the outdated 100 bpm, is generally
agreed upon by experts as the threshold for tachycardia, (2,3).
Brain
General:
This set of symptoms seems the most dramatic in terms of day-to-day
variation. Presumably, this is because of variation in sleep.
Mood: I
perhaps have fluctuations in mood. This is partly associated with
subjective energy levels. Tachycardia tends to improve my mood, though
it can also be uneasy at times. Sometimes when I was feeling
artificially good and energetic, I'd check my heart and it would read
115-125 bpm.
My mood appears to
have a circadian rhythm: good mood in the evening, and poor mood at
night. I believe this may have to do with low blood pressure. I've
measured my blood pressure a couple times when I was feeling weird, and
tested low. Again, it's plausibly my confirmation bias that is saying
so.
Sleep Anxiety: I'm
generally a pretty chill person, but I can experience sleep anxiety
(anxiety about falling asleep). However, I don't always experience it.
I've had some experiences with several hours of relaxing sleep onset
latencies.
Forgetfulness: I
find myself forgetting simple vocabulary. The words don't come to me
'till perhaps a couple days after the fact. Additionally, I can walk
into rooms and forget what I'm doing, or open google and forget what to
search. However, this particular symptom is hard to gauge in comparison
to the general population.
Mental sluggishness:
In addition to my vocabulary faltering altogether, It can take extended
periods to articulate a sentence. Nevertheless, I am, of course,
meticulous. I have delayed response times, and periods of collecting my
thoughts.
Skin
Dry skin:
If I had to characterize my skin, I would say it's dry. In the past,
I've had this issue where the skin around my nose becomes dry and peels.
It seems to appear mostly during the summer. I think I've resolved
this, but I suppose I'll have to wait and see. I've also had small bits
of skin peel on my fingertips, arms, and legs.
Circles under eyes:
I've not yet fully grasped the underpinnings of dark circles.
Naturally, sleep deprivation is one cause. As I understand it, this is
downstream of stress hormones. It can also simply be genetic (e.g. thin
skin under eyes).
Temperature
General:
Subjectively, I feel cold more often than I feel hot. Nevertheless, my
thermal preferences aren't necessarily driven by that fact.
Cold:
I like the cold more than I like heat. However, I find slightly cold
temperatures to be very chilling. It is at extreme cold that I usually
find comfort, though it becomes challenging and/or painful to move my
fingers. My working theory is that, since thermoreceptors sense change
in temperature, matching my periphery to the environment limits the
sensation. I've since found resolution by using warm garments
peripherally, which presumably keeps blood flowing.
Heat: I find heat very bothersome. Heat, naturally, will speed up heart rate and lower blood pressure via vasodilation.
Body Temp:
My central body temperature generally appears slightly elevated, though
within normal limits (e.g. 99F). However, my periphery is normally
quite cold. I can often tell when I shake someone's hand because my
hands are so much colder than theirs. This may be due to lack of warm
clothing rather than something internal. Also, I think the cold
periphery explains the heightened internal temperature, since cold
causes the body to conserve heat.
I
recall one time in particular where my body temperature was high but my
hands were freezing. I was trying out seeing a naturopath to see if
they might be helpful. They took my temperature, and it was high. When I
shook their hands it was evident that my hands were cold. This may all
have been due to me not wearing a jacket. I usually don't like jackets;
they make me uncomfortable.
Sweat:
I used to experience sweating while feeling cold, but it's been a while
since that last happened. I think it was caused by elevated stress
hormones. Both sleep deprivation and missing meals seemed to exacerbate
it. During the day, I would avoid warm garments because of the
discomfort of sweating. At night it would become an issue because I
found it hard to get warm enough, yet also kept sweating. As I said,
these have mostly subsided, probably because of reductions in
physiological stressors as a result of some of the things I've been
doing.
Other:
Appetite:
I have a major problem eating enough. There was a period where I was
trying to get in 2000 calories every day, and found it quite
challenging. Junk food makes calorie consumption quite a bit easier. The
standard calculation estimates my basal metabolic rate at about
1600Kcal per day.
Circadian:
My phenotype is typically that of an extended circadian period (and
corresponding late chronotype). Generally, I've found zeitgebers such as
melatonin, blue light in the morning, and blue blocking glasses at
night to be inadequate.
Paradoxical:
Severe sleep deprivation increases my subjective alertness. Caffeine
sometimes makes me sleepy, particularly if I've accrued a sleep debt.
Likewise, depressants can make me agitated. I attribute most of these
paradoxical effects to autonomic tone as it relates to the heart. For
example, caffeine's ability to lower heart rate could explain the
sedation. (4,5).
Hydroxyzine update:
I
have been taking 350mg of hydroxyzine for a couple weeks or so. It
seemed to make a dramatic difference, particularly at the start. Also,
I've started taking it 3-5 hours before bed, as it doesn't really seem
to kick in for some time. It's possible that this is caused by rate
limited absorption or rate limited blood-brain barrier permeability.
However, I think it's more likely that it is assisting in the nocturnal
drop in stress hormones like e.g. cortisol. Normal subjects experience a
dip in cortisol a couple hours prior to sleep onset, while insomniacs
fail to express this drop, (6).
More interestingly, this elevated evening cortisol can be
experimentally induced the following evening after sleep deprivation, (7).
Therefore, it seems likely that insomnia instigates the cycle, rather
than the other way around. I personally strongly associate with this
research, since the less sleep I get the harder it is to fall asleep the
next night. In any case, this is my proposed mechanism for why taking
hydroxyzine so far in advance is effective. It's worth noting that the
same dosing schedule was not very efficacious at lower doses.
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